CT Scan CA Colon

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CT scan padaCT scan padakeganasan colon-keganasan colon-

rectumrectum Patricia M.Widjaja,SpRPatricia M.Widjaja,SpR

Bag.Radiologi RS HUSADABag.Radiologi RS HUSADA


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CT scan abdomen : keganasan ususCT scan abdomen : keganasan ususbesarbesar

CT scan abdomenCT scan abdomen

biasabiasaCT Colonography,CT Colonography,

virtual conoloscopyvirtual conoloscopy


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CT scan colonographyCT scan colonography

CT colonography merupakanCT colonography merupakanpemeriksaan CT scan khusus usus besarpemeriksaan CT scan khusus usus besaryang non-invasif, peranannya dapatyang non-invasif, peranannya dapatdisamakan dengan konventionaldisamakan dengan konventionalcolonoskopi dalam screening Ca colon .colonoskopi dalam screening Ca colon .Dibandingkan dengan CT scan abdomenDibandingkan dengan CT scan abdomenbiasa, CT colonography membutuhkanbiasa, CT colonography membutuhkanpersiapan yang lebih repot, hampirpersiapan yang lebih repot, hampirsama dengan persiapan untuksama dengan persiapan untukcolonoskopi.colonoskopi.Dibutuhkan indikasi dan tujuan yangDibutuhkan indikasi dan tujuan yang

jelas mengarah pada Ca colon-rectum. jelas mengarah pada Ca colon-rectum.


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Gambaran Ca colorectalGambaran Ca colorectal

acam macam :acam macam :!essile!essile"nnular"nnular#lcerated#lcerated$ecrotic$ecrotic

ucinousucinous

%nvasive%nvasive$on invasive$on invasive

%maging pitfalls :%maging pitfalls :&etained fecal&etained fecalmaterialmaterial

%ncomplete distention%ncomplete distention"dvanced"dvanceddiverticulosisdiverticulosis

'ocal mukosa'ocal mukosathickening due tothickening due toin(ammation process.in(ammation process.


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%n T staging, overall accuracy )as *+%n T staging, overall accuracy )as *+)hen transverse images )ere evaluated)hen transverse images )ere evaluatedalone and + )hen they )ere evaluatedalone and + )hen they )ere evaluatedin combination )ith &s. This di/erencein combination )ith &s. This di/erence)as not signi0cant. $ staging )as)as not signi0cant. $ staging )asassociated )ith an overall accuracy of 12associated )ith an overall accuracy of 12)ith transverse images alone and 3 )ith)ith transverse images alone and 3 )ithcombined transverse and & images 4combined transverse and & images 4 PP 5 .5 .367.367. "ntonella"ntonella FilipponeFilippone et al. ,&adiology 8339,8+6: +-23.et al. ,&adiology 8339,8+6: +-23.


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The prognosis of patients )ith colorectal carcinoma is dependent The prognosis of patients )ith colorectal carcinoma is dependenton the stage of disease at the time of diagnosis. The depth ofon the stage of disease at the time of diagnosis. The depth of)all invasion and the presence of lymph node and distant)all invasion and the presence of lymph node and distantmetastases are the major factors that in(uence prognosis.metastases are the major factors that in(uence prognosis.Detection of colorectal carcinoma before the malignancy hasDetection of colorectal carcinoma before the malignancy hasinvaded into or e tended through the muscularis propria andinvaded into or e tended through the muscularis propria andbefore lymph node metastases have occurred o/ers the bestbefore lymph node metastases have occurred o/ers the bestprognosis for the patient and the option of more limited surgery.prognosis for the patient and the option of more limited surgery.

The use of intravenously administered contrast material to The use of intravenously administered contrast material toenhance the bo)el )all during CT is a relatively recentenhance the bo)el )all during CT is a relatively recent

development in gastrointestinal imaging. To our kno)ledge, "mindevelopment in gastrointestinal imaging. To our kno)ledge, "minet al 4et al 4 6363 ,, 6666 7 )ere the 0rst to describe the use of intravenously7 )ere the 0rst to describe the use of intravenouslyadministered contrast material during dynamic helical CT of anadministered contrast material during dynamic helical CT of anair-insu;ated colon in the detection and staging of colorectalair-insu;ated colon in the detection and staging of colorectalcancer.cancer.


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The overall accuracy of the assessment of lymph node The overall accuracy of the assessment of lymph nodeinvolvement on contrast-enhanced multi of 83 4 3 7 patients by usingtransverse images alone and in 6 of 83 423 7 patients bytransverse images alone and in 6 of 83 423 7 patients byusing transverse images combined )ith &s.using transverse images combined )ith &s.

C ! $g et alC ! $g et al British Journal of Radiology !British Journal of Radiology ! 483387,+6-+*483387,+6-+*


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"bnormal pericolic fat on CT appears as linear ?stands?, ?)isps? or"bnormal pericolic fat on CT appears as linear ?stands?, ?)isps? ornodular opacities, or simply as a ?mistiness? 4?ha@iness? ornodular opacities, or simply as a ?mistiness? 4?ha@iness? or?muckiness?7 in the surrounding fat. "lthough a )ide range of?muckiness?7 in the surrounding fat. "lthough a )ide range ofcauses )ere identi0ed )hen originally described Acauses )ere identi0ed )hen originally described A 66 ,, 88 B, it hasB, it hasbecome generally inferred that in the conte t of colorectal cancerbecome generally inferred that in the conte t of colorectal cancerstaging its presence is suspicious for e tension of tumour beyondstaging its presence is suspicious for e tension of tumour beyondthe muscle coat 4muscularis propria7 and suggestive of at leastthe muscle coat 4muscularis propria7 and suggestive of at leastDukes stage , or T$ stage pT+ or pT9 disease ADukes stage , or T$ stage pT+ or pT9 disease A ++


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"bnormal pericolic fat 4stranding, nodularity, ?mucky? or"bnormal pericolic fat 4stranding, nodularity, ?mucky? or?misty? fat A?misty? fat A 66 ,, 88 B7 may be observed on CT in associationB7 may be observed on CT in association)ith colorectal cancers. %t is generally taken to be)ith colorectal cancers. %t is generally taken to besuspicious of tumour e tension beyond the muscle coat andsuspicious of tumour e tension beyond the muscle coat anda number of studies have used it as a criterion for tumoura number of studies have used it as a criterion for tumourstaging Astaging A ++


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"bnormal pericolic fat on CT appears as linear ?stands?, ?)isps? or"bnormal pericolic fat on CT appears as linear ?stands?, ?)isps? ornodular opacities, or simply as a ?mistiness? 4?ha@iness? ornodular opacities, or simply as a ?mistiness? 4?ha@iness? or?muckiness?7 in the surrounding fat. "lthough a )ide range of causes?muckiness?7 in the surrounding fat. "lthough a )ide range of causes)ere identi0ed )hen originally described A)ere identi0ed )hen originally described A 66 ,, 88 B, it has becomeB, it has becomegenerally inferred that in the conte t of colorectal cancer staging itsgenerally inferred that in the conte t of colorectal cancer staging itspresence is suspicious for e tension of tumour beyond the musclepresence is suspicious for e tension of tumour beyond the musclecoat 4muscularis propria7 and suggestive of at least Dukes stage , orcoat 4muscularis propria7 and suggestive of at least Dukes stage , or

T$ stage pT+ or pT9 disease A T$ stage pT+ or pT9 disease A ++


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Colorectal cancer is a common malignancy that results inColorectal cancer is a common malignancy that results insigni0cant morbidity and mortality. "bdominal computedsigni0cant morbidity and mortality. "bdominal computedtomography 4CT7 is valuable in planning surgery for colon cancertomography 4CT7 is valuable in planning surgery for colon cancerbecause it can demonstrate regional e tension of tumor as )ell asbecause it can demonstrate regional e tension of tumor as )ell asadenopathy and distant metastases. "t CT, colorectal canceradenopathy and distant metastases. "t CT, colorectal cancertypically appears as a discrete soft-tissue mass that narro)s thetypically appears as a discrete soft-tissue mass that narro)s thecolonic lumen. Colorectal cancer can also manifest as focal coloniccolonic lumen. Colorectal cancer can also manifest as focal colonic)all thickening and luminal narro)ing. Complications of primary)all thickening and luminal narro)ing. Complications of primarycolonic malignancies such as obstruction, perforation, and 0stulacolonic malignancies such as obstruction, perforation, and 0stula

can be readily visuali@ed )ith CT. "t CT, local e tension of tumorcan be readily visuali@ed )ith CT. "t CT, local e tension of tumorappears as an e tracolic mass or simply as thickening andappears as an e tracolic mass or simply as thickening andin0ltration of pericolic fat. H tracolic spread is also suggested byin0ltration of pericolic fat. H tracolic spread is also suggested byloss of fat planes bet)een the colon and adjacent organs. Theloss of fat planes bet)een the colon and adjacent organs. Theliver is the predominant organ to be involved )ith metastasesliver is the predominant organ to be involved )ith metastasesfrom colorectal cancer. "t CT, hepatic metastases usually appearfrom colorectal cancer. "t CT, hepatic metastases usually appearas hypoattenuating masses, )hich are best visuali@ed during theas hypoattenuating masses, )hich are best visuali@ed during theportal venous phase of liver enhancement. =ther common sites ofportal venous phase of liver enhancement. =ther common sites ofmetastases from colon cancer include the lungs, adrenal glands,metastases from colon cancer include the lungs, adrenal glands,and bones. #se of CT is critical for identifying recurrences,and bones. #se of CT is critical for identifying recurrences,evaluating anatomic relationships, documenting ?normal?evaluating anatomic relationships, documenting ?normal?postoperative anatomy, and con0rming the absence of ne)postoperative anatomy, and con0rming the absence of ne)lesions during and after therapy.lesions during and after therapy.


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Colorectal cancer is the second most common cause of cancer death in developedColorectal cancer is the second most common cause of cancer death in developedcountries. %n 622 , there )ere 6+6,333 ne) cases of colorectal cancer and 1>,333countries. %n 622 , there )ere 6+6,333 ne) cases of colorectal cancer and 1>,333deaths in the #nited !tates 467. The initial diagnosis is usually made )ithdeaths in the #nited !tates 467. The initial diagnosis is usually made )ithcolonoscopy or air-barium enema e aminationI ho)ever, )ith the increased use ofcolonoscopy or air-barium enema e aminationI ho)ever, )ith the increased use ofcomputed tomography 4CT7 as the initial imaging modality in patients )ith a varietycomputed tomography 4CT7 as the initial imaging modality in patients )ith a varietyof gastrointestinal symptoms, the radiologist may be the 0rst to suggest theof gastrointestinal symptoms, the radiologist may be the 0rst to suggest thediagnosis of colon cancer on the basis of CT 0ndings. $evertheless, at this time, CTdiagnosis of colon cancer on the basis of CT 0ndings. $evertheless, at this time, CTis not routinely performed for detection of colon cancer, although continuedis not routinely performed for detection of colon cancer, although continuedadvancements in scanner and computer technology may allo) CT to play a futureadvancements in scanner and computer technology may allo) CT to play a futurerole in detection of polyps and early-stage colon cancer.role in detection of polyps and early-stage colon cancer.

The current role of CT in patients )ith kno)n colon cancer is controversial. "ccuracy The current role of CT in patients )ith kno)n colon cancer is controversial. "ccuracyrates for preoperative staging of colon cancer )ith CT have been disappointing,rates for preoperative staging of colon cancer )ith CT have been disappointing,ranging bet)een 9 and ** 487. Jimitations of CT staging include an inabilityranging bet)een 9 and ** 487. Jimitations of CT staging include an inabilityto de0nitively identify nodes that contain tumor or to determine the e act depth ofto de0nitively identify nodes that contain tumor or to determine the e act depth oftumor invasion through the )all. Despite these limitations, CT is valuable in thetumor invasion through the )all. Despite these limitations, CT is valuable in the

management of colon cancer. reoperative CT is useful for planning surgery ormanagement of colon cancer. reoperative CT is useful for planning surgery orradiation therapy, particularly )hen local e tension of tumor into adjacent organsradiation therapy, particularly )hen local e tension of tumor into adjacent organsor distant metastases are detected. %n addition, preoperative CT provides baselineor distant metastases are detected. %n addition, preoperative CT provides baseline0ndings for comparison during the postoperative period and is the modality of0ndings for comparison during the postoperative period and is the modality ofchoice for detection of local recurrence after surgical resection.choice for detection of local recurrence after surgical resection.Given the prevalence of colon cancer in the #nited !tates and the role of CT inGiven the prevalence of colon cancer in the #nited !tates and the role of CT inpreoperative staging, treatment planning, and postoperative follo)-up, thepreoperative staging, treatment planning, and postoperative follo)-up, theradiologist should be familiar )ith the CT appearance of colon cancer. This articleradiologist should be familiar )ith the CT appearance of colon cancer. This articlediscusses the techniKue of colon CT, staging of colon cancer, primary tumors, localdiscusses the techniKue of colon CT, staging of colon cancer, primary tumors, local

spread, metastases, tumor recurrence, and therapeutic considerations.spread, metastases, tumor recurrence, and therapeutic considerations.


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Colon cancer in a *9-year-old man. Contrast material-enhanced spiralColon cancer in a *9-year-old man. Contrast material-enhanced spiralCT scan sho)s luminal narro)ing and marked )all thickeningCT scan sho)s luminal narro)ing and marked )all thickening

involving the right side of the transverse colon 4arro)7. There isinvolving the right side of the transverse colon 4arro)7. There isadjacent stranding of the serosa and mesenteric fat, a 0ndingadjacent stranding of the serosa and mesenteric fat, a 0nding

compatible )ith local tumorcompatible )ith local tumor e tension.e tension.


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"denocarcinoma in a >9-year-old )oman )ith right lo)er"denocarcinoma in a >9-year-old )oman )ith right lo)erKuadrant pain. Contrast-enhanced CT scan sho)s markedKuadrant pain. Contrast-enhanced CT scan sho)s markedcircumferential thickening of the cecum 4curved arro)s7.circumferential thickening of the cecum 4curved arro)s7.

The )all has a lo)-attenuation component 4straight arro)7, The )all has a lo)-attenuation component 4straight arro)7,)hich is due to necrosis. There is also stranding of the)hich is due to necrosis. There is also stranding of thepericolic fat, a 0nding suggestive of tumor invasion throughpericolic fat, a 0nding suggestive of tumor invasion through

the )all. "denocarcinoma )as con0rmed at endoscopythe )all. "denocarcinoma )as con0rmed at endoscopy ..


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"denocarcinoma in an 2-year-old )oman )ith severe"denocarcinoma in an 2-year-old )oman )ith severeabdominal pain. !piral CT scan obtained )ith oral contrastabdominal pain. !piral CT scan obtained )ith oral contrastmaterial sho)s segmental circumferential thickening of thematerial sho)s segmental circumferential thickening of thehepatic (e ure 4arro)s7 )ith ascites. "denocarcinoma )ashepatic (e ure 4arro)s7 )ith ascites. "denocarcinoma )ascon0rmed at colonoscopy and biopsy.con0rmed at colonoscopy and biopsy.


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&ectal cancer in a >1-year-old man )ith rectal bleeding. !piral CT&ectal cancer in a >1-year-old man )ith rectal bleeding. !piral CTscan obtained )ith rectal contrast material sho)s an eccentricscan obtained )ith rectal contrast material sho)s an eccentric

rectal cancer 4black arro)7 as )ell as adjacent nodes 4)hiterectal cancer 4black arro)7 as )ell as adjacent nodes 4)hite

arro)s7.arro)s7.


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Diverticulitis in a 98-year-old man )ith pain and heme-positiveDiverticulitis in a 98-year-old man )ith pain and heme-positivestools. CT scan obtained )ith oral contrast material sho)s focal,stools. CT scan obtained )ith oral contrast material sho)s focal,masslike thickening of the sigmoid colon 4straight arro)s7 )ithmasslike thickening of the sigmoid colon 4straight arro)s7 )ithadjacent stranding of the pericolic fat. =n the basis of the CTadjacent stranding of the pericolic fat. =n the basis of the CTappearance and clinical history, colon cancer )as suspected. "tappearance and clinical history, colon cancer )as suspected. "tendoscopy, diverticulitis )as diagnosed. %n retrospect, theendoscopy, diverticulitis )as diagnosed. %n retrospect, thepresence of minimal adjacent mesenteric (uid 4curved arro)7presence of minimal adjacent mesenteric (uid 4curved arro)7favored diverticulitis.favored diverticulitis.

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CT Scan CA Colon

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